A simple and cost-effective early-patient interaction process can help ensure that South Africans who are diagnosed with tuberculosis (TB) in hospitals receive continued care once they've been referred to clinics for TB treatment and are registered in local treatment registers.

Such a process is particularly important in a country with a high TB burden and where, for example, about 20% of diagnosed patients in Cape Town are not reliably included in the national TB treatment register and are often not successfully linked to care at clinics.

This is according to a new study conducted by researchers from the Desmond Tutu TB Centre at Stellenbosch University.

Titled “Early interactions with newly diagnosed TB patients in hospital can support linkage to care", the study* was published recently in the peer-reviewed open-access journal Public Health Action.

​As part of their study, the researchers implemented an early patient interaction process with adults newly diagnosed with TB at a district hospital in Cape Town between August 2020 and March 2021.

The patient interaction process, which focused on updating patient contact details, provided practical information and allowed patients the opportunity to ask questions. It was also aimed at improving the health outcomes of patients.

Through the interaction process, the researchers were able to confirm the contact details of patients, provide TB and health information, share information on accessing care at clinics and answer patients' questions in their home language.

The researchers point out that the failure to link individuals diagnosed with TB to care remains an important gap in the TB care cascade in South Africa.

“Compared to people diagnosed at primary healthcare (PHC) facilities, people diagnosed in hospitals are more likely to require additional support to be linked with PHC TB treatment services. Those diagnosed at hospitals are, however, less likely to be registered or linked to care. A previous study showed that 85% of patients who die after not accessing care in Cape Town, were diagnosed in a hospital. This means that early intervention at this point is vital."

“We found that most patients had inadequate contact details on file and engaging in the interaction process led to updated information. Collecting updated contact information meant that accurate information could be shared with PHC facilities, community health workers and other public health initiatives, such as contact tracers, to locate patients after they have been discharged and to help them receive the necessary care.

“Patients appreciated the opportunity to learn more about their diagnosis and ask questions, and the interactions provided them with some autonomy to make decisions about their health, including where to access TB treatment. They welcomed practical and health information in their home language."

“The implementation of the step-by-step process can enable patients to better understand their diagnoses and allow them to better manage their own health, which is in line with the patient- centred care approach proposed in the End TB strategy of the World Health Organisation," add the researchers.

They say that implementing a patient interaction process as part of routine care is a feasible strategy to facilitate the early initiation and registration of TB, as well as linkage to care for patients diagnosed in hospital.

“Although there are multiple benefits to implementing detailed and substantive patient engagement interventions, these programmes can be labour-intensive and time-consuming.

“Embedding an early interaction process within the patient discharge process using staff already involved during discharge would make this process cost-effective and time efficient. However, it would require updated and available data about TB diagnoses."

The researchers emphasise the need for future research that can explore the reasons for the delay in linkage to care and can also evaluate how low-cost interactions can be helpful to people who were newly diagnosed with TB at a hospital but were not linked to care at a PHC facility within 30 days of discharge.

They add that there is a need for greater awareness of TB symptoms and for patients to be able to seek healthcare as soon as possible.

*The study was supported by the Bill &Melinda Gates Foundation.

• Source: L. Viljoen, P. Hendricks, G. Hoddinott, N. Vanqa, M. Osman, A. C. Hesseling & S-A. Meehan 2022. Early interactions with newly diagnosed TB patients in hospital can support linkage to care. Public Health Action, Volume 12 (3): doi.org/10.5588/pha.22.0012.

Photo by CDC on Unsplash.

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